Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | A40647 | CA |
NPI | 1467404004 |
---|---|
Provider Name | Mrs. Lucia Rusu |
First Address | Sacramento, CA 95814-6414 |
Second Address | Costa Mesa, CA 92626-6143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BR1901734 | DEA (01) | |
C35518 | (02) |